Validation and potential usefulness of the updated PROMISE Minimal Risk Tool in patients with suspected coronary artery disease undergoing coronary CT angiography

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The steady decline in test positivity among patients with suspected coronary artery disease (CAD) has raised interest developing strategies to identify who may not require testing. updated PROMISE minimal-risk tool (PMRT) was developed specifically for this purpose, but never tested our population. aim study assess the diagnostic performance new tool, and compare it guideline-recommended pre-test probability (PTP) risk factor-weighted clinical likelihood (RF-CL) model a Portuguese cohort symptomatic undergoing computed tomography angiography (CCTA). Methods We conducted two-centre cross-sectional CCTA CAD. Key exclusion criteria were age <30 years, known CAD, acute syndrome or symptoms other than chest pain dyspnoea. A simplified version PMRT (without HDL-C), guideline PTP, RF-CL score calculated each patient. Obstructive CAD defined as any luminal stenosis ≥ 50% on CCTA. ‘Low risk’ absence obstructive calcium (CAC) < 100 (both conditions present, where results are unlikely change patient management). cut-off value 95% positive predictive identifying identified ROC curve analysis. Results total 2162 (mean 60±11years, 59% female) included. Overall, 14.9% (N=323) had 73.5% (N=1589) fulfilled risk’. Patients more frequently female, higher prevalence non-anginal fewer cardiovascular factors. For discriminative power similar one provided by PTP models (Figure 1A). However, risk’, showed greater (Figure1B). detecting at "Low risk" >46%. 458 (21.2%) Conclusion In CCTA, models. criterion that Risk" present roughly fifth would be less likely derive benefit from